Allum Laura, Homden Leah, Hart Nicholas, Connolly Bronwen, Pattison Natalie, Rose Louise
Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, London, United Kingdom.
Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
Crit Care Explor. 2025 May 13;7(5):e1265. doi: 10.1097/CCE.0000000000001265. eCollection 2025 May 1.
Few quality improvement (QI) tools are specifically designed to manage the care of patients experiencing prolonged critical illness. This risks omissions in care. To determine the implementation feasibility and clinician acceptability of our QI tool "Recover25," we focused on actionable processes of care for patients with an ICU stay of over 7 days and their families.
Parallel convergent mixed-methods feasibility study conducted between February 2024 and May 2024.
A mixed ICU in London, United Kingdom.
Patients with an ICU stay of more than 7 days, and the staff who care for them.
We invited representatives of all ICU professions to a weekly QI round.
We recorded the time completed Recover25, the amount and type of actions generated following Recover25 use (i.e., what new care activities did it prompt), and the number and profession of staff attending each round. We administered the Theoretical Framework of Acceptability (TFA) questionnaire and conducted semi-structured clinician interviews. We calculated means (sds) or interquartile ranges (IQRs) (percentiles) of time to complete and a number of actions generated. We analyzed and integrated qualitative data using framework analysis informed by the TFA. "Recover 25" was used 34 times (65%) of 52 opportunities with 26 patients. Median (IQR) Recover25 completion time was 9.75 minutes (8.2-14.9 min) with a completion rate of 96% (89-100%). Recover25 usage prompted a median of 1 (IQR) (1-2) new action. There was a mean of 4 (sd 2) interprofessional team members attending each QI round. Nineteen clinicians completed 33 TFA questionnaires and 11 interviews. Recover25 was perceived as acceptable, with 94% reporting it aligned with their principles of good care, 85% perceiving it as a coherent intervention, and 67% perceiving it was effective. Interview data showed participants valued the emphasis on person-centered care and highlighted ways to improve implementation.
Recover25 was perceived as feasible to implement and acceptable by staff. Further work is needed to understand the effects on patient experience and outcomes.
专门设计用于管理危重症持续时间较长患者护理的质量改进（QI）工具很少。这存在护理疏漏的风险。为了确定我们的QI工具“Recover25”的实施可行性和临床医生的可接受性，我们重点关注了入住重症监护病房（ICU）超过7天的患者及其家属的可操作护理流程。
2024年2月至2024年5月进行的平行收敛性混合方法可行性研究。
英国伦敦的一家综合性ICU。
入住ICU超过7天的患者及其护理人员。
我们邀请了所有ICU专业的代表参加每周一次的QI轮会。
我们记录了完成Recover25的时间、使用Recover25后产生的行动数量和类型（即它促使了哪些新的护理活动）以及参加每轮会议的工作人员数量和专业。我们发放了可接受性理论框架（TFA）问卷并进行了半结构化的临床医生访谈。我们计算了完成时间的均值（标准差）或四分位数间距（IQR）（百分位数）以及产生的行动数量。我们使用由TFA指导的框架分析来分析和整合定性数据。在52次机会中，对26名患者使用了34次（65%）“Recover 25”。Recover25的中位（IQR）完成时间为9.75分钟（8.2 - 14.9分钟），完成率为96%（89 - 100%）。Recover25的使用促使中位数为1（IQR）（1 - 2）项新行动。每次QI轮会平均有4名（标准差2）跨专业团队成员参加。19名临床医生完成了33份TFA问卷并接受了11次访谈。Recover25被认为是可接受的，94%的人报告它符合他们的优质护理原则，85%的人认为它是一种连贯的干预措施，67%的人认为它是有效的。访谈数据显示参与者重视对以患者为中心的护理的强调，并突出了改进实施的方法。
Recover25被认为实施可行且工作人员可接受。需要进一步开展工作以了解其对患者体验和结局的影响。
